慢加急性肝衰竭的定义、预后评估及诊治进展

毕占虎; 王临旭; 连建奇

doi:10.3969/j.issn.1001-5256.2022.07.041

慢加急性肝衰竭的定义、预后评估及诊治进展

DOI: 10.3969/j.issn.1001-5256.2022.07.041

空军军医大学第二附属医院传染科，西安 710038

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：毕占虎负责撰写论文；王临旭负责修改论文；连建奇负责拟定写作思路，指导撰写文章并最后定稿。

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通信作者:
连建奇，lianjq@fmmu.edu.cn

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出版历程
- 收稿日期: 2022-01-04
- 出版日期: 2022-07-20

Definition, prognostic assessment, and advances in the diagnosis and treatment of acute-on-chronic liver failure

Department of Infectious Diseases, The Second Affiliated Hospital of Air Force Medical University, Xi'an 710038, China

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Corresponding author: LIAN Jianqi, lianjq@fmmu.edu.cn

摘要

摘要: 慢加急性肝衰竭(ACLF)是一种在慢性肝病基础上发生肝功能急性失代偿的临床综合征，目前全球尚无统一定义标准。其显著特征是肝病进展迅速，常伴发多器官功能衰竭，短期病死率高。慢性肝病以慢性病毒性肝炎和酒精性肝病最为常见。感染、酒精、肝毒性药物等是其发生的主要诱因，但有高达40%~50%的ACLF病例没有可识别的诱发因素。早期发现并准确评估病情对ACLF患者至关重要，但目前仍缺乏早期预警并准确评估病情的理想方法。目前的治疗方法主要为器官支持和并发症的治疗，肝移植是唯一能够改善预后的治疗手段，但如何选择合适的患者以及肝移植的时机仍存在一定争议。
- 慢加急性肝衰竭 /
- 预后 /
- 诊断 /
- 治疗学
Abstract: Acute-on-chronic liver failure (ACLF) is a clinical syndrome with acute decompensation of liver function on the basis of chronic liver diseases, and at present, there is still no unified definition standard for this disease in the world. ACLF is characterized by rapid progression of liver disease, multiple organ failure, and high short-term mortality. Chronic viral hepatitis and alcoholic liver disease are the most common chronic liver diseases, and infection, alcohol, and hepatotoxic drugs are the main predisposing factors for this disease, but up to 40%-50% of ACLF cases have no identifiable predisposing factors. Early identification and accurate assessment of disease conditions are crucial to ACLF patients, but there is still a lack of ideal assessment methods for early warning and accurate assessment. Currently, the main treatment methods are organ support and treatment of complications, and liver transplantation is the only treatment method that can improve prognosis; however, there are still controversies over the selection of appropriate patients and the timing of liver transplantation.
- Acute-on-Chronic Liver Failure /
- Prognosis /
- Diagnosis /
- Therapeutics

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表 1 ACLF患者的预后评分系统

Table 1. Prognostic scoring systems used in patients with ACLF

评分系统	年份	开发目的	评价指标	评分公式
CTP	1964年	预测门静脉曲张手术风险	HE、腹水、TBil、Alb、PT	无
MELD	2000年	评估行TIPS的肝硬化患者短期预后	TBil、INR、Cr、病因	3.8×ln TBil+11.2×ln INR+9.6×ln Cr+6.4×病因(胆汁性或酒精性0、其他1)
MELD-Na	2006年	MELD评分的发展	TBil、INR、Cr、病因、血清Na⁺	MELD+1.59×(135 -血清Na⁺)
iMELD	2007年	MELD评分的发展	TBil、INR、Cr、病因、血清Na⁺、年龄	MELD+(0.3×年龄)-(0.7×血清Na⁺)+100
CLIF-SOFA	2013年	专门用于评估ACLF患者预后	TBil、Cr、HE分级、INR、平均动脉压、PaO₂/FiO₂或SpO₂/FiO₂	无
CLIF-C OF	2014年	CLIF-C SOFA的简化版，用于ACLF诊断和分级	TBil、Cr、HE分级、INR、平均动脉压、PaO₂/FiO₂或SpO₂/FiO₂	无
CLIF-C ACLF	2014年	评价ACLF预后	TBil、Cr、HE分级、INR、平均动脉压、PaO₂/FiO₂或SpO₂/FiO₂、年龄、WBC	10×(0.33×CLIF-OF+0.04×年龄+0.63×ln WBC-2)
COSSH-ACLF	2018年	评价HBV-ACLF预后	TBil、Cr、HE分级、INR、平均动脉压、PaO₂/FiO₂或SpO₂/FiO₂、年龄	0.741×INR+0.523×HBV-SOFA+0.026×年龄+0.003×TBil
注：TIPS，经颈静脉肝内门体分流术；Cr，肌酐；PaO₂，氧分压；FiO₂，吸入气体氧含量；SpO₂，动脉血氧饱和度。

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